Case study: Overcoming adversity and avoiding a ‘compromise of integrity’
by Carolyn Riel
By definition, “adversity relates to any difficulty or misfortune, essentially any barrier a person faces, whether it be socioeconomic, due to race or ethnicity, or any other limiting factors that would pose itself in the opposition to the accomplishment of one’s life purpose,” according to Jane Doe, a CDI professional and ACDIS source who wishes to remain anonymous.
People face adversity in their personal daily lives, but also in the professional sphere, which can limit their career opportunities and foster an unhealthy work environment. While CDI is often seen as a friendly, welcoming group, CDI professionals do face this type of professional adversity based on things they cannot change about themselves, leaving them to determine what overcoming it might look like.
Before you can challenge and overcome adversity, you must be able to recognize its effects on your own life and work as well as in the lives of your coworkers and peers. Take note of the challenges levied at you—or a coworker—when you’re trying to advance or accomplish business goals and objectives, Doe suggests.
When Doe was hired to be the director of CDI in a new location, she knew that, given the area in which she would be working, she might be one of only a handful of minority individuals in leadership. Doe says that she went into the situation with an open mind and focused on her status as a licensed, educated, and experienced professional with proof that she could perform the role.
“I’ve been involved in CDI for 15 years and have worked as a director and consultant, so I knew exactly what I needed to do in terms of educating staff, building relationships, influencing, coaching, and mentoring,” she says. “I had this full plan of building and working toward a degree of communication within the team where we could have optimistic attitudes for pursuing goals set before us, not only achieving metrics but developing a level of cohesiveness in the team to be respectful of one another.”
That mentality, however, was quickly challenged by the existing organizational culture, attitude, and experiences based on turnover in leadership prior to her onboarding. When you experience this sort of pushback, she suggests reaching out for help from internal and external sources.
“I sought out help internally first by going to the head of the revenue cycle department and didn’t find much support. I went to other colleagues and directors for advice on this from people who had worked there for years,” Doe says. “I wanted to overcome the behaviors I was experiencing, and they were helpful to the best of their ability, but they also had their own priorities for meeting revenue cycle goals.”
After exhausting the internal avenues for help, Doe looked externally for support. “I started consulting with subject matter experts in the industry, such as other HIM professionals, to gain their opinion and make sure I was adhering to the best practices,” she says.
Her initial efforts were met with limited success, Doe says, so she then consulted with vendors contracted with her organization. “They told me that they were excited in times of leadership turnover and staff turnover to have someone like myself in the role that was engaged and enthusiastic about moving forward,” she says. Despite the positive response, however, nothing concrete came out of their support.
Though she wasn’t finding the help that she needed at the time, Doe says that it became apparent to people outside the CDI department that there was a problem.
“Those who weren’t directly experiencing the adversity noticed in our weekly meetings that there were barriers stopping me from making forward movement for the program,” she says. “They noticed that there was a degree of frustration. They themselves even expressed frustration for me and noted what I was experiencing.”
For example, Doe’s coworkers noticed that, while her recommendations for improving the CDI program were good, they weren’t being supported and executed by the rest of the department. Those recommendations included having staff complete refresher training, instituting coding audits, and adopting new technology.
“The EHR technology as it was wasn’t functioning optimally; there was no good reporting data,” she says. “I made recommendations for us to look into new CDI and EHR software, and people above me were very aware it was a pain point.” Despite the apparent need for updates, however, her suggestions were not well received or adopted.
Doe also ran into adversity with her immediate team. Even though she made herself available to them both during staff meetings and throughout the day, team members often chose to take their concerns and thoughts directly to the chief financial officer (CFO), bypassing her as their director.
“They weren’t being transparent with their communication with the CFO, and people kept going above me talking to these higher-ups without talking to me about things like their career moves,” she says. “It was really undermining me in my position.”
In her experience, nothing she said was met with excitement or engagement, but with defensiveness instead. “One team member was working remotely and told me she was getting too many emails from me in a day, and her response went from zero to 60,” Doe says. “Instead of talking with me about it and saying how she felt, she went to the CFO for it all and said she felt attacked.”
Doe says that from her perspective, it all boiled down to the fact that no one had established accountability, acknowledgment, or best practices for how to handle such a situation. Eventually, the situation escalated to a meeting with the associate vice president and the CFO to determine the root cause of the disconnect between her and the rest of the CDI team.
At the time, Doe thought the team’s significant leadership and staff turnover could have caused the disconnect. “I asked those higher-ups to pop into a meeting, maybe send a cohesive message as to where we are and where we’ve been, where we’re going to really establish my placement,” she says. “Instead, I was met with a question of if they even needed me at all.”
There are a number of things people can do to fight adversity in the workplace, and they almost always start at the organizational level. Doe says that facilities have to take matters of adversity seriously and that a robust diversity and inclusion training program is imperative. If these conversations are part of the regular staff onboarding process, the organization sends a clear message that it will not tolerate exclusion from its employees. (For more information about the difference between diversity and inclusion, see the article on p. 6.)
If you are experiencing adversity, or seeing someone else experiencing adversity, reach out to someone who is skilled in addressing these concerns, Doe suggests.
When people hear that an issue has been escalated to human resources (HR), they often think that means the problem was egregious. “But it doesn’t have to involve something severe and serious to the point of [HR] taking action that involves suspension or termination. There’s coaching and mentoring that can take place, measuring the stages of relationship development within a team,” she says. HR can assist a team with the stages of change by using professional development services, the education department, or specialized consulting agencies.
On a personal level, Doe says self-care routines are important when facing adversity. “Eat a healthy diet, exercise, make sure to drink enough water,” she says. “Dehydration can negatively affect our mental status in different ways and cause our cognition to be off.” She also recommends getting a good night’s rest, keeping healthy relationships with family and friends, and engaging in hobbies and special interests to keep your mind as happy as possible.
When it comes to talking to coworkers about adversity, there are steps an individual can—and should—take as well. “I generally rely on experience and ask open-ended questions to open up the opportunity for sharing from every individual involved,” Doe says. “First make sure they’re comfortable with communicating those experiences they’ve had, for the sole purpose of establishing consensus among the group and having a comfortable environment to exchange that sensitive information.”
If you go to your organization for help, seek HR’s advice, and speak to colleagues, yet still are facing adversity, Doe recommends looking at the bigger picture and remaining optimistic. “As personal as adversity can feel, there are times where it’s going to be best for your headspace to not take it internally,” she says.
In Doe’s case, she ended up leaving the organization for a more welcoming environment, understanding that sometimes one’s own mental health must take the wheel.
“One would sometimes say that resigning is not overcoming adversity,” she says. “In this case for me, it was. [Staying would have required] a compromise of integrity and reputation and professionalism, or a risk of loss of compliance. That’s non-negotiable for me.”